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1.
Int. braz. j. urol ; 48(1): 110-119, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356276

ABSTRACT

ABSTRACT Introduction: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. Materials and Methods: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. Results: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). Conclusions: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.


Subject(s)
Humans , Laparoscopy , Kidney Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Nephrectomy/adverse effects , Nephrons/surgery
2.
Int. braz. j. urol ; 47(1): 149-158, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134310

ABSTRACT

ABSTRACT Purpose: Renal artery pseudoaneurysms (RAPs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening complications after partial nephrectomy (PN). Selective arterial embolization (SAE) is an effective method for controlling RAPs/AVFs. We assessed the clinical factors affecting the occurrence of RAPs/AVFs after PN and the effects of SAE on postsurgical renal function. Materials and Methods: Four hundred ninety-three patients who underwent PN were retrospectively reviewed. They were placed in either the SAE or the non-SAE group. The effects of clinical factors, including R.E.N.A.L. scores, on the occurrence of RAPs/AVFs were analyzed. The influence of SAE on the estimated glomerular filtration rate (eGFR) during the first postoperative year was evaluated. Results: Thirty-three (6.7%) patients experienced RAPs/AVFs within 8 days of the median interval between PN and SAE. The SAE group had significantly higher R.E.N.A.L. scores, higher N component scores, and higher L component scores (all, p <0.05). In the multivariate analysis, higher N component scores were associated with the occurrence of RAPs/AVFs (Odds ratio: 1.96, p=0.039). In the SAE group, the mean 3-day postembolization eGFR was significantly lower than the mean 3-day postoperative eGFR (p <0.01). This difference in the eGFRs was still present 1 year later. Conclusions: Renal tumors located near the renal sinus and collecting system were associated with a higher risk for RAPs/AVFs after PN. Although SAE was an effective method for controlling symptomatic RAPs/AVFs after PN, a procedure-related impairment of renal function after SAE could occur and still be present at the end of the first postoperative year.


Subject(s)
Humans , Arteriovenous Fistula/etiology , Aneurysm, False/etiology , Kidney Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Glomerular Filtration Rate , Nephrectomy/adverse effects
3.
Int. braz. j. urol ; 46(6): 1021-1028, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134271

ABSTRACT

ABSTRACT Objective To study the arterial segments of ovine kidney, present a proportional volume analysis of each kidney arterial segment, and analyze arterial injuries caused by simulated partial nephrectomy of cranial pole. Materials and Methods Forty-eight ovine kidneys injected with polyester resin into the renal arteries and collecting system were used in this study. Eighteen kidneys were used to study the arterial segments and the proportional volume of each renal segment. Other 30 kidneys were submitted to superior pole resection at a distance of 1.0cm, 0.5cm, or exactly at the cranial hilar edge, just before the resin hardening. These endocasts were used to evaluate the arterial injuries caused by these different resection planes. Results Ovine renal artery divided into two (ventral and dorsal) or three segmental arteries. Dorsal segment presented higher proportional volume than ventral segment. For kidneys with three segments, the third segment was on the caudal region (caudo-ventral or caudo-dorsal segment) and presented the lowest proportional volume. None of the resected kidneys (at 1.0, 0.5 or at the cranial hilar edge) presented injury of arterial branches that irrigate non-resected region. Conclusion The segmental distribution of renal artery, the proportional volume of each segment and arterial injuries after cranial pole resection in ovine kidneys are different from what is observed in human kidneys. Meanwhile, ovine kidneys show a primary segmental division on anterior and posterior, as in humans, but different from swine. These anatomical characteristics should be considered when using ovine as animal models for renal experimental and/or training procedures.


Subject(s)
Animals , Vascular System Injuries , Nephrectomy/adverse effects , Renal Artery , Swine , Sheep , Models, Animal , Kidney/surgery
4.
Int. braz. j. urol ; 45(6): 1227-1237, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056325

ABSTRACT

ABSTRACT Introduction: Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK. Materials and methods: After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals. Results: We identified 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria. Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Solitary Kidney/physiopathology , Solitary Kidney/epidemiology , Nephrectomy/adverse effects , Postoperative Period , Prognosis , Proteinuria/physiopathology , Proteinuria/epidemiology , Acidosis, Renal Tubular/physiopathology , Acidosis, Renal Tubular/epidemiology , Prevalence , Retrospective Studies , Risk Factors , Follow-Up Studies , Colombia/epidemiology , Age of Onset , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/epidemiology , Glomerular Filtration Rate/physiology , Hypertension/physiopathology , Hypertension/epidemiology
5.
Int. braz. j. urol ; 45(6): 1136-1143, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056335

ABSTRACT

ABSTRACT Purpose: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. Materials and Methods: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results. Results: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically significant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. Conclusions: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Clinical Competence , Adipose Tissue, White/surgery , Learning Curve , Robotic Surgical Procedures/methods , Nephrectomy/methods , Postoperative Complications , Body Mass Index , Prospective Studies , Treatment Outcome , Statistics, Nonparametric , Perioperative Period , Operative Time , Robotic Surgical Procedures/adverse effects , Glomerular Filtration Rate , Middle Aged , Nephrectomy/adverse effects
6.
Int. braz. j. urol ; 45(5): 932-940, Sept.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1040076

ABSTRACT

ABSTRACT Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.


Subject(s)
Humans , Male , Female , Adult , Aged , Postoperative Complications/etiology , Proteinuria/complications , Preoperative Period , Acute Kidney Injury/etiology , Nephrectomy/adverse effects , Reference Values , Logistic Models , Predictive Value of Tests , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Risk Assessment , Acute Kidney Injury/physiopathology , Glomerular Filtration Rate/physiology , Kidney Neoplasms/surgery , Middle Aged , Nephrectomy/methods
7.
Int. braz. j. urol ; 45(3): 531-540, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012328

ABSTRACT

ABSTRACT Purpose: Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients. Materials and Methods: This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals. Results: The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade ≥3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008). Conclusions: Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Nephrectomy/methods , Postoperative Complications , Carcinoma, Renal Cell/mortality , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Kaplan-Meier Estimate , Kidney Neoplasms/mortality , Middle Aged , Nephrectomy/adverse effects , Nephrectomy/mortality
8.
Int. braz. j. urol ; 45(1): 193-193, Jan.-Feb. 2019.
Article in English | LILACS | ID: biblio-1040052

ABSTRACT

ABSTRACT Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.


Subject(s)
Humans , Kidney Transplantation/adverse effects , Laparoscopy/adverse effects , Vascular System Injuries/etiology , Nephrectomy/adverse effects , Retrospective Studies , Living Donors , Risk Reduction Behavior , Computed Tomography Angiography , Middle Aged , Nephrectomy/methods
9.
Int. braz. j. urol ; 45(1): 100-107, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-989963

ABSTRACT

ABSTRACT Objectives: Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, involving high complication rate. The objective of our study was to identify predictors for complications of nephrectomy for urolithiasis. Patients and Methods: A retrospective review of 149 consecutive patients > 18y submitted to simple nephrectomy for urolithiasis from January 2006 to July 2012 was performed. Clinical data, computed tomography findings and pathology report were analyzed. Postoperative complications were categorized based on Clavien - Dindo classification. Logistic multivariate regression models assessed the predictors for surgical complications of nephrectomy for urolithiasis. Results: Eighty-three (55.7%) patients were submitted to laparoscopic nephrectomy and 66 (44.2%) to open procedure. Conversion to open surgery was necessary in 19.2% (16 / 83). On univariable analysis, higher preoperative chronic kidney stage (p = 0.02), Charlson comorbidity index ≥ 2 (p = 0.04), higher ASA score (p = 0.001), urgency due to sepsis (p = 0.01), kidney size ≥ 12 cm (p = 0.006), renal and perirenal abscess (p = 0.004 and 0.002 respectively) and visceral adhesion (p = 0.04) were associated with Clavien - Dindo score > 1. On multivariate analysis, higher ASA score (p = 0.01), urgency due to sepsis (p = 0.03), kidney size ≥ 12 cm (p = 0.04) and preoperative abscess (p = 0.04) remained significantly associated with complications. End - stage renal disease with dialysis was needed post - operatively in 3.4% (5 / 144) of patients. Conclusions: We identified that higher ASA score, urgency due to sepsis, kidney size ≥ 12 cm and preoperative abscess were associated with Clavien - Dindo score > 1.


Subject(s)
Humans , Male , Female , Adult , Aged , Laparoscopy/adverse effects , Urolithiasis/surgery , Nephrectomy/adverse effects , Postoperative Complications , Retrospective Studies , Laparoscopy/methods , Kaplan-Meier Estimate , Middle Aged
10.
Rev. Col. Bras. Cir ; 46(3): e20192092, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1013157

ABSTRACT

RESUMO Objetivo: investigar os fatores de risco de conversão para cirurgia aberta na nefrectomia laparoscópica (NL) para urolitíase. Métodos: foram revisados os dados de todos os pacientes maiores de 18 anos de idade submetidos à NL entre janeiro de 2006 e maio de 2013 em nossa Instituição. Índice de Charlson, escore ASA, função renal pela equação e estágio de MDRD (Modification of Diet in Renal Disease), achados de tomografia computadorizada (TC) pré-operatória, complicações pela classificação de Clavien-Dindo e taxa de conversão foram analisados. Determinaram-se os fatores de risco para conversão por meio de regressão logística. Resultados: oitenta e quatro pacientes foram submetidos à LN, sendo que 16 (19%) tiveram seu procedimento convertido para cirurgia aberta devido à forte aderência do hilo renal aos órgãos adjacentes. Outras causas associadas à conversão foram sangramento excessivo (n=6) e lesão do intestino grosso (n=3). Na análise univariada, cirurgia renal prévia, borramento da gordura perirrenal, abscesso renal, abscesso perirrenal, abscesso pararrenal, fístula, aderência ao fígado ou baço e aderência ao intestino foram associados à conversão. Na análise multivariada, abscesso pararrenal e aderência ao intestino foram fatores de risco significativos para a conversão. Conclusão: abscesso pararrenal e aderência ao intestino demonstrados na TC pré-operatória são fatores de risco de conversão para cirurgia aberta em LN por urolitíase.


ABSTRACT Objective: to investigate the risk factors for conversion to open surgery in laparoscopic nephrectomy (LN) for urolithiasis. Methods: we reviewed data on all patients over 18 years of age submitted to LN between January 2006 and May 2013 at our institution. We analyzed the Charlson's index, the ASA score, renal function by the equation and stage of MDRD (Modification of Diet in Renal Disease), preoperative computed tomography (CT) findings, complications by the Clavien-Dindo classification and conversion rate. We used logistic regression analysis to determine the risk factors for conversion. Results: eighty-four patients underwent LN, 16 (19%) sustaining convertion to open surgery due to the strong adhesion of the renal hilum to the adjacent organs. Other causes associated with conversion were excessive bleeding (n=6) and lesion of the large intestine (n=3). In the univariate analysis, previous renal surgery, perirenal fat blurring, renal abscess, perirenal abscess, pararenal abscess, fistula, adherence to the liver or spleen, and adherence to the intestine were associated with conversion. In the multivariate analysis, pararenal abscess and adherence to the intestine were significant risk factors for conversion. Conclusion: pararenal abscess and bowel adhesions demonstrated in the preoperative CT are risk factors for conversion to open surgery in LN due to urolithiasis.


Subject(s)
Humans , Male , Female , Adult , Laparoscopy/methods , Urolithiasis/surgery , Nephrectomy/methods , Tomography, X-Ray Computed , Retrospective Studies , Risk Factors , Laparoscopy/adverse effects , Urolithiasis/diagnostic imaging , Preoperative Period , Middle Aged , Nephrectomy/adverse effects
11.
Int. braz. j. urol ; 44(4): 740-749, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954072

ABSTRACT

ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.


Subject(s)
Humans , Male , Female , Aged , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/physiopathology , Risk Assessment/methods , Kidney/physiopathology , Kidney Neoplasms/surgery , Kidney Neoplasms/physiopathology , Nephrectomy/methods , Postoperative Period , Reference Values , Time Factors , Carcinoma, Renal Cell/pathology , Logistic Models , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Creatinine/blood , Warm Ischemia/methods , Preoperative Period , Glomerular Filtration Rate , Kidney/surgery , Kidney/blood supply , Kidney/pathology , Kidney Neoplasms/pathology , Middle Aged , Nephrectomy/adverse effects
12.
Int. braz. j. urol ; 44(2): 280-287, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-892978

ABSTRACT

ABSTRACT Objectives This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.


Subject(s)
Humans , Male , Female , Adult , Aged , Pyelonephritis/surgery , Tuberculosis, Renal/surgery , Pyonephrosis/surgery , Hand-Assisted Laparoscopy/adverse effects , Kidney Diseases/surgery , Nephrectomy/methods , Nephritis/surgery , Pyelonephritis, Xanthogranulomatous/surgery , Reproducibility of Results , Blood Loss, Surgical , Intestinal Fistula/surgery , Colonic Diseases/surgery , Operative Time , Fistula/surgery , Length of Stay , Middle Aged , Nephrectomy/adverse effects
13.
Rev. cuba. med. mil ; 47(1): 33-4, ene.-mar. 2018. tab
Article in Spanish | LILACS | ID: biblio-960592

ABSTRACT

Introducción: el adenocarcinoma renal representa hasta el 80 por ciento de los tumores sólidos de este órgano, además de ser el de peor pronóstico. Objetivo: analizar la influencia del estadio tumoral inicial en la sobrevida de pacientes con adenocarcinoma renal. Métodos: se realizó un estudio descriptivo en una muestra de 69 pacientes con diagnóstico de adenocarcinoma renal, atendidos en el Hospital Militar Central Dr. Luis Díaz Soto de enero de 2005 a diciembre de 2014. Las variables estudiadas fueron: edad, sexo, signos y síntomas, exámenes imaginológicos utilizados, estadio tumoral, modalidades terapéuticas empleadas, complicaciones presentadas y la sobrevida posterior al tratamiento. Resultados: prevaleció el grupo de edades de 60-69 años con 46 pacientes (66,7 por ciento) y del sexo masculino con 42 para un 61 por ciento. Predominó el diagnóstico incidental en 52 pacientes (75,4 por ciento). El ultrasonido se empleó en la totalidad de los casos y fue positivo en el 98,6 por ciento. Preponderaron las lesiones en el estadio I en 32 pacientes (46,3 por ciento). La modalidad terapéutica más empleada fue el tratamiento quirúrgico en 65 pacientes (94,2 por ciento), al ser la nefrectomía total por vía lumbar la más practicada con 44 pacientes (63,8 por ciento). La sobrevida a los 5 años fue del 93,7 por ciento. Conclusiones: El diagnóstico del adenocarcinoma renal en estadios iniciales, posibilitó mejor pronóstico y mayor sobrevida de los pacientes. Existió relación directa entre los factores pronósticos, clínicos y tumorales, con la evolución y la mortalidad por adenocarcinoma renal(AU)


Introduction: the renal adenocarcinoma represents until 80 percent of the solid tumors of this organ, besides being that of worse prognosis. Objective: to analyze the influence of the initial tumoral stage in the survival of patient with renal adenocarcinoma. Methods: A descriptive was carried in to sample of 69 patients with diagnosis of renal adenocarcinoma, assisted in the Central Military Hospital Dr. Luis Díaz Soto from January of 2005 to December of 2014. The studied variables were: age, sex, signs and symptoms, imaginologic exams used, tumoral stage, therapeutic modalities employed, complications and the survival later to the treatment. Results: the group of 60-69 year-old ages prevailed with 46 patients (66.7 percent) and of the masculine sex with 42 for 61 percent. The incidental diagnosis prevailed in 52 patients (75.4 percent). The ultrasound was used in the entirety of the cases and it was positive in 98.6 percent. Prevailed the lesions in the I stage in 32 patients (4.3 percent). The therapeutic modality more employed was the surgical treatment in 65 patients (94.2 percent), being the total nephrectomy for lumbar via were practiced in 44 patients (63.8 percent). The survival to the 5 years was of the one 93.7 percent. Conclusions: The diagnosis of the renal adenocarcinoma, in initial stages, facilitates a better prognosis and a bigger survival of the patients. Direct relationship exists among the prognostic factors, clinical and tumoral, with the evolution and the mortality for renal(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Survival Analysis , Kidney Neoplasms/epidemiology , Nephrectomy/adverse effects , Carcinoma, Renal Cell/diagnostic imaging , Epidemiology, Descriptive
14.
Int. braz. j. urol ; 43(4): 671-678, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-892870

ABSTRACT

ABSTRACT Objectives Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate. Materials and methods Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data. Results Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. Conclusion Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.


Subject(s)
Humans , Male , Female , Adult , Renal Veins/diagnostic imaging , Kidney Transplantation/methods , Tissue and Organ Harvesting/methods , Kidney/blood supply , Nephrectomy/methods , Renal Veins/abnormalities , Retrospective Studies , Treatment Outcome , Laparoscopy/methods , Living Donors , Creatinine/blood , Tomography, Spiral Computed , Warm Ischemia , Operative Time , Middle Aged , Nephrectomy/adverse effects
15.
Int. braz. j. urol ; 43(2): 209-215, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-840819

ABSTRACT

ABSTRACT Purpose To compare the oncologic and clinical outcomes for open partial nephrectomy (OPN) performed in patients with entirely intraparenchymal tumors versus case-matched controls, with exophytic lesions. Material and methods Patients having undergone OPN between 2007 and 2012 were investigated. Exclusion criteria included patients with a benign tumor, advanced malignancy, malignancies other than renal cell carcinoma, end-stage renal failure, or 3 or more co-existing chronic diseases. Individuals with tumors that were invisible at the renal surface were identified, and then matched with 2 controls chosen for tumor size, pathology, age, follow-up period, and presence of a solitary kidney. Oncological status, perioperative, and postoperative data were collected and compared between groups. Results 17 individuals with entirely endophytic RCC tumors and available oncologic status were identified. For five patients, only one suitable control could be identified, bringing the control group number to 29. All tumors were clear cell carcinomas staged at pT1a. Median tumor size was 25mm for endophytic lesions, and 27mm for exophytic masses (P=0.32). The operative period was extended by 20 minutes for intrarenal tumors (P=0.03), with one case of a positive surgical margin in each group (P=0.7). There were no significant differences in perioperative or postoperative complications. Median follow-up was 47 and 43 months for patients with endophytic and exophytic tumors respectively. Disease recurrence was recorded in one patient after endophytic tumor resection, and in four controls (P=0.4). Conclusions OPN shows equivalent safety and efficacy for both intrarenal RCC tumors and exophytic tumors of the same size and type.


Subject(s)
Humans , Male , Female , Aged , Carcinoma, Renal Cell/surgery , Parenchymal Tissue/surgery , Kidney Neoplasms/surgery , Nephrectomy/adverse effects , Nephrectomy/methods , Postoperative Complications , Time Factors , Carcinoma, Renal Cell/pathology , Case-Control Studies , Follow-Up Studies , Treatment Outcome , Statistics, Nonparametric , Tumor Burden , Warm Ischemia , Operative Time , Parenchymal Tissue/pathology , Intraoperative Complications , Kidney Neoplasms/pathology , Middle Aged , Neoplasm Recurrence, Local
16.
Medicina (B.Aires) ; 77(2): 95-99, Apr. 2017. tab
Article in Spanish | LILACS | ID: biblio-894439

ABSTRACT

Nefrectomía radical se asocia a disminución progresiva de función renal. Los parámetros en insuficiencia renal post-nefrectomía están identificados, no así la importancia de la histopatología vascular en la pieza de nefrectomía. Nuestro objetivo fue evaluar si la gravedad de la aterosclerosis en tejido renal no neoplásico puede predecir la evolución del filtrado glomerular en pacientes con nefrectomía total. Se incluyeron 31 pacientes con nefrectomía radical unilateral, no donantes. Edad promedio 68.5 ± 11.8 años, 80% tenían antecedentes de hipertensión, 64% sobrepeso, 51% fumadores. Se estimó tasa de filtración glomerular preoperatoria, postoperatoria y a 6, 12 y 24 meses de cirugía. Se determinó grado de arteriolosclerosis según porcentaje de estrechamiento de luz vascular (grado 0: sin estrechamiento vascular; grado 1: menos del 25%; grado 2: 25-50%; grado 3: más del 50%). Los 10 pacientes con arteriolosclerosis grado 0 tuvieron mayor tasa de filtración glomerular basal (75 ± 13 ml/min/1.73 m²) que los 8 con grado 2 y 3 (55 ± 22 ml/min/1.73 m2) (p 0.0886). En la última evaluación, la tasa de filtrado glomerular fue 60 ± 13 ml/min/1.73 m² (grado 0) y 39 ± 11 ml/min/1.73 m² (grados 2 y 3) (p = 0.05). La disminución del filtrado glomerular fue mayor en grados más graves de ateroesclerosis (sin significación estadística). El análisis histológico de piezas quirúrgicas de nefrectomía permitiría identificar aquellos con mayor riesgo de progresión de enfermedad renal según gravedad de las lesiones vasculares ateroscleróticas.


Radical nephrectomy is associated with a progressive decline in renal function. Clinical parameters in post-nephrectomy insufficiency were described but the impact of histopathologic vascular findings in the non-neoplastic kidney of nephrectomy specimen, has been poorly studied. Our aim was to evaluate whether the severity of atherosclerosis in non-neoplastic renal tissue predicts the evolution of glomerular filtration rate in patients undergoing total nephrectomy. Thirty-one non-donor patients with unilateral radical nephrectomy were included. Average age was 68.5 ± 11.8 years, 80% had a history of hypertension, 64% overweight and 51% were smokers. The glomerular filtration rate was estimated preoperatively, postoperatively and at 6, 12 and 24 months after surgery. Arteriolosclerosis was scored based on degree of narrowing of the vascular lumen (stage 0: no vascular narrowing; stage 1: less than 25%; stage 2: 25-50%; stage 3: more than 50%). Ten patients in stage 0 had higher basal glomerular filtration rate (75 ± 13 ml/min/1.73 m²) than eight patients in stage 2 or 3 (55 ± 22 ml/min/1.73 m²) (p 0.0886). At the last postoperative evaluation, the glomerular filtration rate was 60 ± 13 ml/min/1.73 m² (stage 0) and 39 ± 11 ml/min/1.73 m² (stage 2 or 3) (p = 0.05). The decrease in glomerular filtration rate was higher in patients with more severe degrees of atherosclerosis but the difference was not statistically significant. The histological evaluation of the severity of arteriosclerosis in the whole kidney allows the identification of patients with a greater risk of decreased glomerular filtration rate after a post radical nephrectomy.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Renal Insufficiency, Chronic/etiology , Atherosclerosis/complications , Kidney/blood supply , Nephrectomy/adverse effects , Time Factors , Severity of Illness Index , Retrospective Studies , Risk Factors , Disease Progression , Atherosclerosis/pathology , Glomerular Filtration Rate , Kidney/surgery , Kidney/pathology
17.
Acta cir. bras ; 31(11): 744-752, Nov. 2016. tab, graf
Article in English | LILACS | ID: biblio-827663

ABSTRACT

ABSTRACT PURPOSE: To characterize an experimental model of progressive renal disease induced by different degrees of nephrectomy in rats. METHODS: Eighty male Wistar rats were divided into four experimental groups (n=20/group): sham surgery (control group), progressive degrees of nephrectomy leading to mild uremia (group 1), moderate uremia (group 2) and severe uremia (group 3). Ten animals of each group were followed for two or four weeks. At the end, blood and 24-hour urine samples were collected to determine renal function parameters. Urine output and water and food intake were daily monitored. RESULTS: In rats of group 1, serum levels of creatinine and urea and microalbuminuria were increased, while reduced creatinine clearance (p<0.05, compared with control group), without changing blood pressure. Animals of group 2 had more accentuated alterations: increases in urinary output, blood pressure, serum concentrations of urea, creatinine, sodium, potassium, and in microalbuminuria, and reduction of creatinine clearance (p<0.05). Group 3 exhibited even more increased serum concentrations of urea, creatinine, sodium and potassium, blood pressure and microalbuminuria, and decreased creatinine clearance (p<0.05) in comparison with control group and unilateral nephrectomy. CONCLUSION: Progressive nephrectomy in rats seems to be useful to study the physiopathology of chronic kidney disease and its mechanisms of progression.


Subject(s)
Animals , Male , Rats , Uremia/metabolism , Kidney/physiopathology , Kidney Failure, Chronic/physiopathology , Nephrectomy/adverse effects , Urea/blood , Uremia/etiology , Severity of Illness Index , Rats, Wistar , Disease Progression , Creatinine/blood , Albuminuria/blood , Disease Models, Animal , Arterial Pressure/physiology , Glomerular Filtration Rate/physiology , Kidney Failure, Chronic/pathology , Nephrectomy/methods
18.
Rev. cuba. med. mil ; 45(2): 0-0, abr.-jun. 2016. ilus
Article in Spanish | LILACS | ID: biblio-960535

ABSTRACT

Introducción: la pielonefritis xantogranulomatosa es una enfermedad infecciosa, inflamatoria, crónica e inusual que afecta el parénquima renal. El tratamiento definitivo es la nefrectomía. Objetivos: presentar un nuevo caso de pielonefritis xantogranulomatosa, así como la secuencia diagnóstica y terapéutica adoptada. Métodos: paciente masculino de 61 años de edad, con antecedentes de hipertensión arterial, diabetes mellitus tipo II e infecciones urinarias a repetición, que asistió al cuerpo de guardia del Hospital Militar Central Dr. Luis Días Soto, por presentar dolor lumbar y en flanco derechos, de 2meses de evolución, intenso y punzante, asociado a fiebre de 40̊ C, escalofríos y marcada toma del estado general. En el examen del hemiabdomen derecho presentaba una masa tumoral de unos 10cm de diámetro, dolorosa, ligeramente movible y de superficie lisa. El urocultivo reportó Escherichiacoli. El ultrasonido abdominal evidenció una imagen compleja en el riñón derecho, y la tomografía axial computarizada un tumor heterogéneo, que medía 10,7x7, 6 cm de contornos regulares, que distorsionaba la grasa perirrenal con densidades de hasta 73 UH. Resultados: el paciente fue sometido a nefrectomía total derecha transperitoneal, por sospecha de tumor renal, proceder que transcurrió sin complicaciones. Los hallazgos microscópicos de la pieza quirúrgica revelaron infiltración de linfocitos, histiocitos y macrófagos llenos de lípidos, compatible con pielonefritis xantogranulomatosa. La evolución fue satisfactoria. Conclusiones: aunque el diagnóstico definitivo de la pielonefritis xantogranulomatosa es histopatológico, la forma tumoral de presentación de la misma, es uno de los diagnósticos diferenciales a tener en cuenta en pacientes diabéticos con infecciones recurrentes del tracto urinario(AU)


Introduction: Xanthogranulomatous pyelonephritis is an infectious, inflammatory, chronic, and unusual disease that affects the renal parenchyma. The definitive treatment is nephrectomy. Objectives: Present a new case of xanthogranulomatous pyelonephritis, as well as the diagnostic and therapeutic sequence adopted. Methods: A 61-year-old male patient with a history of hypertension, type II diabetes mellitus and recurrent urinary tract infections attended Dr. Luis Díaz Soto Central Military Hospital, for presenting intense and stabbing lumbar and right flank pain, of 2 months of evolution, associated with fever of 40 ° C, chills and marked the general condition. In the examination of the right abdomen a tumor mass was found of about 10 cm in diameter, painful, slightly movable and of smooth surface. The urine culture reported escherichiacoli. Abdominal ultrasound showed a complex image in the right kidney, and computed tomography scan showed a heterogeneous tumor, measuring 10.7x7.6 cm of regular contours, distorting the perirenal fat with densities of up to 73 UH. Results: The patient underwent transperitoneal right total nephrectomy, due to suspicion of renal tumor. This procedure had no complications. Microscopic findings of the surgical specimen revealed infiltration of lymphocytes, histiocytes, and lipid-filled macrophages, consistent with xanthogranulomatous pyelonephritis. The evolution was satisfactory. Conclusions: Although the definitive diagnosis of xanthogranulomatous pyelonephritis is histopathological, the tumoral presentation form is one of the differential diagnoses to be considered in diabetic patients with recurrent urinary tract infections(AU)


Subject(s)
Humans , Male , Middle Aged , Urinary Tract Infections/etiology , Pyelonephritis, Xanthogranulomatous/diagnostic imaging , Nephrectomy/adverse effects
19.
Acta cir. bras ; 31(6): 417-421, tab
Article in English | LILACS | ID: lil-785013

ABSTRACT

ABSTRACT PURPOSE: To evaluate the effect of Otostegia persica (O. persica) extract on renal damage induced by ischemia/reperfusion (I/R) in diabetic rats. METHODS: Forty-eight rats were subjected to right nephrectomy; then, they were allocated into six groups: Sham; Diabetic sham; I/R; Diabetic I/R; I/R+O. persica; Diabetic I/R+O. persica. Diabetes was induced by streptozotocin (200 mg/kg, i.p.). O. persica (300 mg/kg/day, p.o) was administered for 2 weeks. On the 15th day, ischemia was induced in left kidney for 60 min, followed by reperfusion for 24h. Renal functional and biochemical markers were estimated. RESULTS: I/R in both normal and diabetic rats, induced a significant elevation in serum levels of urea and creatinine (p<0.05). Renal I/R induced a significant increase of malondialdehyde, myeloperoxidase and nitric oxide concentrations associated with significant reduction in superoxide dismutase and catalase activities in comparison with the sham group (p<0.05). Diabetic rats that underwent renal I/R exhibited a significant increase in all the studied parameters with a reduction in the antioxidant enzymes as compared to nondiabetic rats (p<0.05). These deleterious effects associated with renal I/R were improved by the treatment with O. persica (p<0.05). CONCLUSION: Otostegia persica pretreatment protected the renal injury from ischemia-reperfusion in diabetic rats.


Subject(s)
Animals , Male , Plant Extracts/pharmacology , Reperfusion Injury/complications , Lamiaceae , Diabetes Mellitus, Experimental/complications , Antioxidants/pharmacology , Superoxide Dismutase/metabolism , Urea/blood , Blood Glucose/drug effects , Reperfusion Injury/metabolism , Catalase/metabolism , Rats, Wistar , Peroxidase/metabolism , Oxidative Stress/drug effects , Creatinine/blood , Models, Animal , Hypoglycemic Agents/pharmacology , Kidney/drug effects , Lipid Peroxides/metabolism , Nephrectomy/adverse effects
20.
Rev. cuba. med ; 55(1): 0-0, ene.-mar. 2016. tab
Article in Spanish | LILACS | ID: lil-780758

ABSTRACT

Introducción: el trasplante renal constituye la terapéutica de elección en el tratamiento de la enfermedad renal crónica, pero las complicaciones infecciosas, específicamente bacterianas, mantienen elevadas tasas de morbilidad y mortalidad y constituyen un problema de difícil solución. En el Hospital Universitario Arnaldo Milián Castro contamos con 8 años de experiencia en el tratamiento de la infección bacteriana en receptores de trasplante renal. Objetivo: caracterizar el comportamiento de la infección bacteriana en receptores de trasplante renal. Métodos: se efectuó un estudio descriptivo, longitudinal y prospectivo que incluyó a 102 pacientes receptores de TR con diagnóstico de infecciones bacterianas, entre junio de 2001 y diciembre de 2009, y 192 infecciones bacterianas confirmadas por estudios microbiológicos. Resultados: se localizaron 9 procesos infecciosos en el parénquima pulmonar con clínica, radiografía y respuesta antimicrobiana sin positividad en los especímenes recolectados y procesados en el laboratorio. El grupo etario más afectado fue el de 31 a 40 años con 32 procesos infecciosos. No hubo diferencias en cuanto al sexo ni a la relación sexo-edad. Predominó la piel blanca (74,5 por ciento) (x² BA= 0,064 p= 0,936). Los que exhibieron una sola infección fueron los más representados (50 por ciento) y el urocultivo fue el espécimen con más positividad, 94 para un índice de 0,92. Los grupos de pacientes con uno y dos episodios infecciosos tuvieron 2 fallecidos cada uno al egreso (p= 0,278). La infección del tracto urinario y la herida quirúrgica predominaron en el posoperatorio inmediato, con 16 casos, respectivamente, aunque la primera se presentó más frecuentemente en los diferentes períodos evolutivos. El microorganismo más resistente fue el Acinetobacter spp. en el cultivo de orina en 3 pacientes (10,34 por ciento) y el antimicrobiano menos efectivo, la combinación de amoxicilina-sulbactán, en 8 (21,05 por ciento). Conclusiones: el conocimiento de las características de la infección bacteriana en receptores de trasplante renal y la selección oportuna y específica del antimicrobiano a la dosis recomendada han sido las herramientas principales en nuestra experiencia(AU)


Introduction: renal transplantation is the therapy of choice in the treatment of chronic kidney disease, but specifically bacterial infectious complications maintain high rates of morbidity and mortality and it is a problem difficult to solve. At Arnaldo Milian Castro University, eight year-experience has been gained in the treatment of bacterial infection in renal transplant recipients. Objective: characterize the bacterial infection behavior in renal transplant recipients. Methods: a descriptive, longitudinal and prospective study was conducted from June 2001 to December 2009, in 102 patients receiving renal transplantation and who were diagnosed with bacterial infections; and 192 bacterial infections confirmed by microbiological education. Results: nine infectious processes were located in the pulmonary parenchyma with clinic, X-ray images and antimicrobial answer with no positiveness in the specimens gathered and processed in the laboratory. The most affected age group was 31 to 40 years with 32 infectious processes. There were no differences in gender or sex-age relationship. White skin subjects prevailed (74.5 percent) (x² BA = 0.064 p = 0.936). Those who exhibited a single infection were overrepresented (50 percent) and urine culture was more positive specimen, 94 for an index of 0.92. Patient groups one and two infectious episodes had 2 deaths each at discharge (p = 0.278). The wound and urinary tract infections prevailed in the immediate postoperative period, with 16 cases, respectively, although the latter was more likely at different evolutive periods. Acinetobacter spp was the most resistant microorganism in urine culture in 3 patients (10.34 percent) and the less effective antimicrobial was amoxicillin-sulbactam, in 8 (21.05 percent). Conclusions: the timely and specific selection of the antimicrobial drug at the recommended dose for each patient has been the main tool in our experience(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Bacterial Infections/drug therapy , Urinary Tract Infections/drug therapy , Kidney Transplantation/methods , Anti-Infective Agents/therapeutic use , Nephrectomy/adverse effects , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
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